MKSAP Questions of the Week

Neurology Q 20

A 49-year-old-man is evaluated 1 day after having an episode of right arm weakness without pain that lasted 5 minutes. He is now asymptomatic. The patient has type 2 diabetes mellitus and dyslipidemia. Medications are aspirin, metformin, and atorvastatin. On physical examination, blood pressure is 126/68 mm Hg, pulse rate is 86/min and regular, and respiration rate is 12/min. No carotid bruits or cardiac murmurs are heard on cardiac auscultation. All other physical examination findings are normal. An electrocardiogram shows normal sinus rhythm with no ST-segment or T-wave changes.

Publish date: 09/23/2020

 
Nephrology Q 32

A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks' gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin. On physical examination, the patient is afebrile, blood pressure is 102/62 mm Hg, and pulse rate is 80/min. Pain and bruising over the left chest wall are noted. Abdominal examination findings are consistent with changes of pregnancy. Laboratory studies are significant for a serum sodium level of 132 mEq/L (132 mmol/L).

Publish date: 09/17/2020

 
Infectious Disease Q 9

A 44-year-old woman is evaluated for persistent fatigue, headache, myalgia, and arthralgia. Early localized Lyme disease was diagnosed 2 months ago after the patient returned from a camping trip in western New Jersey with the symptoms described and a skin eruption of erythema migrans. She was treated with a 14-day course of doxycycline with resolution of the cutaneous lesions but continuation of the other symptoms, which now are adversely affecting her work and personal life. Her only medication is ibuprofen.

Publish date: 09/09/2020

 
Hematology and Oncology Q 12

A 50-year-old woman undergoes follow-up evaluation for a right iliofemoral deep venous thrombosis diagnosed 6 weeks ago by Doppler ultrasonography. She reports no new symptoms and notes her right leg edema is improving. She has no history of travel, surgery, or immobility. She indicates feeling well before her diagnosis, with no shortness of breath. She had a normal screening colonoscopy 3 months ago and a normal mammogram and Pap smear 6 months ago. Medical history is otherwise unremarkable. Her only medication is rivaroxaban.

Publish date: 09/02/2020

 
General Internal Medicine Q 24

A 54-year-old man is evaluated for a 6-month history of right shoulder pain. He describes the pain as moderately severe aching that is diffusely localized over the shoulder without radiation to the arm. The pain is constant, although it is worse at night and with any shoulder movement. The pain was insidious in onset and has been progressively worsening. He has had no neurologic or constitutional symptoms. Ibuprofen provides some pain relief.

Publish date: 08/26/2020

 
Gastroenterology and Hepatology Q 13

A 30-year-old man is evaluated for ongoing symptoms of dysphagia. He was previously diagnosed with eosinophilic esophagitis on upper endoscopy and has completed an 8-week course of swallowed aerosolized fluticasone, which did not alleviate his symptoms. He takes no other medications. On physical examination, vital signs are normal; BMI is 25. Other findings, including those of an abdominal examination, are unremarkable. Upper endoscopy shows an area of high-grade stenosis in the distal esophagus.

Publish date: 08/19/2020

 
Endocrinology Q 22

A 19-year-old woman is evaluated for irregular menstrual cycles since menarche at 12 years of age, increasing amount of coarse facial hair, and acne. Symptoms have worsened since she stopped playing high school sports and subsequently gained weight. She is most concerned about the hair growth and acne. Medical history is otherwise unremarkable, and she takes no medications.

Publish date: 08/12/2020

 
Dermatology Q2

A 25-year-old man is evaluated for recurrent skin eruption with oval lesions on the chest and upper back, which are occasionally itchy. The lesions began in late spring and worsened over the summer. Medical history is unremarkable, and he takes no medications. On physical examination, vital signs are normal.

Publish date: 08/06/2020

 
Cardiovascular Medicine Q 2

A 69-year-old man is evaluated in the hospital for four episodes of chest pain at rest in the past 24 hours. Medical history is significant for hyperlipidemia, hypertension, tobacco use, and previous transient ischemic attack. Medications are aspirin, hydrochlorothiazide, atorvastatin, and ramipril.

Publish date: 07/29/2020

 
Rheumatology Q 8

A 55-year-old woman is evaluated for an 18-month history of increasingly severe knee pain with the inability to arise when seated on the floor. She does not have pain at rest or nocturnal pain. Medications are celecoxib and omeprazole. On physical examination, vital signs are normal. Bony hypertrophy of both knees is present. There is no warmth, erythema, or swelling of the joints. Plain anteroposterior knee radiographs show medial joint space narrowing, peaking of the tibial spines, and osteophytes; there are no erosions or osteopenia.

Publish date: 07/22/2020

 
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